title: Application of a first impression triage in the Japan railway west disaster.
abstract: On April 25, 2005, a Japanese express train derailed into a building, resulting in 107 deaths and 549 injuries. We used "First Impression Triage (FIT)", our new triage strategy based on general inspection and palpation without counting pulse/respiratory rates, and determined the feasibility of FIT in the chaotic situation of treating a large number of injured people in a brief time period. The subjects included 39 patients who required hospitalization among 113 victims transferred to our hospital. After initial assessment with FIT by an emergency physician, patients were retrospectively reassessed with the preexisting the modified Simple Triage and Rapid Treatment (START) methodology, based on Injury Severity Score, probability of survival, and ICU stay. FIT resulted in shorter waiting time for triage. FIT designations comprised 11 red (immediate), 28 yellow (delayed), while START assigned six to red and 32 to yellow. There were no statistical differences between FIT and START in the accuracy rate calculated by means of probability of survival and ICU stay. Overall validity and reliability of FIT determined by outcome assessment were similar to those of START. FIT would be a simple and accurate technique to quickly triage a large number of patients.
authors.affiliation: Department of Emergency, Disaster and Critical Care Medicine, Hyogo College of Medicine, Nishinomiya, Hyogo 663-8501, Japan. qq-hashi@hyo-med.ac.jp
authors.forename: Atsunori
authors.initials: A
authors.lastname: Hashimoto
authors.forename: Takahiro
authors.initials: T
authors.lastname: Ueda
authors.forename: Kazutoshi
authors.initials: K
authors.lastname: Kuboyama
authors.forename: Taihei
authors.initials: T
authors.lastname: Yamada
authors.forename: Mariko
authors.initials: M
authors.lastname: Terashima
authors.forename: Atsushi
authors.initials: A
authors.lastname: Miyawaki
authors.forename: Atsunori
authors.initials: A
authors.lastname: Nakao
authors.forename: Joji
authors.initials: J
authors.lastname: Kotani
mesh_terms: D000465:Algorithms; D004189:Disaster Planning / Q000379:methods* / Q000592:standards; D006801:Humans; D015601:Injury Severity Score; D007564:Japan / Q000453:epidemiology; D017063:Outcome Assessment, Health Care; D010173:Palpation / Q000379:methods; D011674:Pulse; D011890:Railroads; D015203:Reproducibility of Results; D056152:Respiratory Rate; D012189:Retrospective Studies; D014218:Triage / Q000379:methods* / Q000592:standards; D014947:Wounds and Injuries / Q000401:mortality* / Q000628:therapy